Provider Demographics
NPI:1295916187
Name:FAMILY THERAPY & DEVELOPMENT CENTERS INC
Entity type:Organization
Organization Name:FAMILY THERAPY & DEVELOPMENT CENTERS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:JANENE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:DONARSKI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, MSW
Authorized Official - Phone:269-982-3832
Mailing Address - Street 1:4384 LAUREL DRIVE
Mailing Address - Street 2:
Mailing Address - City:ST JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085
Mailing Address - Country:US
Mailing Address - Phone:269-982-3832
Mailing Address - Fax:269-281-0351
Practice Address - Street 1:2460 LAKESHORE DR
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-1874
Practice Address - Country:US
Practice Address - Phone:269-982-3832
Practice Address - Fax:269-281-0351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-19
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802080845320800000X
MI6801087845101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental IllnessGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI62-79049Medicaid
MI0P21820Medicare PIN
MI62-79049Medicaid